Peer Review

An Approach to Development of a Public Health Minor

The University of Nebraska at Kearney recognized as early as 2004 that there was reason to introduce public health study into the undergraduate curriculum. Faculty and administrative leaders observed that threats to public health had become increasingly compelling and urgent. Once-eradicated illnesses had begun reappearing; new diseases were emerging. In view of globalization and global disparities in health care, and such realities as, for example, widespread misunderstandings of the benefits of immunizations, we concluded that this trend is likely to continue. In the United States, life expectancy now ranks just twenty-fifth of thirty-seven developed countries. Obesity levels have reached the highest ever recorded here, with approximately 65 percent of the population overweight. Obesity increases the risk of many chronic illnesses and adds stress to the health care system. We became concerned about the education of health care workers. A number of studies make the case that public health workers in the United States need enhanced field-based professional training. We began to hear of a public health workforce shortage. Faced with these realities, we decided to join the growing numbers of health care workers, educators, and business executives who understand the need to know more about and do more on behalf of public health. In short, we identified a societal need and took steps to be responsible.

Our local situation also presented incentives. The University of Nebraska at Kearney has a long history of providing quality undergraduate education for a variety of health professions. A program in public health would expand opportunities and complement existing programs. In addition, the committee organized to explore and plan recognized that with more than five hundred pre-health-science majors on our campus, we could add a valuable option to career choices. In light of the state of Nebraska’s decision to use tobacco settlement funds to create local public health departments across the state, we saw an immediate workforce need for education in public health. We therefore decided to move ahead promptly.

In fall 2007, we designed an interdisciplinary minor in public health, housed in the Health Sciences department. The minor is based on an arts and sciences model for universities without public health schools or programs, as discussed in the consensus report published by the Council of Colleges of Arts and Science (CCAS) (Riegelman, Albertine, and Persily 2007). This model would allow us to reach the widest possible range of students.

Our success thus far in developing and implementing the interdisciplinary minor on our campus prompts us to offer a few insights into the process. We hope such insights will make the adventure a little easier for those developing a minor at a university or college that does not have a public health school or program.

Our initial planning began with goal setting. We had the good fortune to receive support for the new initiative from central administration of the university and were able to add a faculty line in public health. A physician with public health experience took the position and became instrumental in developing the plan as we started to lay out our goals. Among the many possible sources of expertise, a new hire worked well for us.

We set out to prepare students to be better informed consumers and advocates, and leaders of good health practices. Students would also gain skills and knowledge, we reasoned, to understand and participate effectively within the health care economy and have the wherewithal to approach and influence health care policy and regulations. We were intrigued by the idea of educated citizenship, as the Institute of Medicine of the National Academy of Sciences recommends (Gebbie, Rosenstock, and Hernandez 2003). We therefore developed our minor with the goal of citizenship first. In addition, an interdisciplinary public health minor would add a new dimension to students’ major degree work, whatever the field, and could provide job opportunities for our graduates. We hoped frankly that students would discover an active interest in public health and wish to pursue advanced degrees in the field.

Wanting not to work in a vacuum, in 2006 we decided to conduct an online search of courses offered in minor programs at other colleges and universities. There was limited data since most existing programs offered an undergraduate major in public health. We had nothing close to the resources, staffing, and depth available in a major program. Enough information on minors emerged, however, for us to see patterns and commonalities among existing programs. Almost all minors required a minimum of three core courses: introduction to public health (Public Health 101), epidemiology (again a 100-level course), and statistics (any level).

We then met with faculty from many departments, including biology, health science, chemistry, exercise science, business, economics, marketing, and sociology, as well as other disciplines. Knowing our campus culture, we saw wisdom in hearing our colleagues’ views of curriculum and content for the twenty-four credit hours in the minor. Navigating the competing interests of different departments was certainly a cross-disciplinary challenge. The enthusiasm each faculty member brought was encouraging, but the competition added to the difficulties of developing an interdisciplinary program that would meet our broader goals.

Gathering input from the faculty across disciplines, we generated a list of possible required courses. As we expected, the list exceeded the twenty-four hours needed to complete a minor and offered no opportunity for electives. That meant we had to rethink the concept of required courses. We decided to limit requirements to the three courses most commonly offered at other undergraduate institutions: Public Health 101, Epidemiology 101, and statistics. The nine-credit-hour limit allowed for greater inclusion and input from a variety of departments, creating the interdisciplinary approach the committee intended. Departments appreciated the opportunity to suggest courses from their respective areas as electives. They wanted a degree of ownership of the project. The cross-disciplinary buy-in settled, the committee decided to house the new interdisciplinary minor in the department of health sciences (HSCI).

The core courses were ultimately approved through governance as submitted. Those courses are listed in table 1. The CCAS consensus report was not yet available for comparison and review when we began this work. One concern in the approval process was whether the epidemiology course should be taught at the 100 level or a higher level. Wherever the course was placed, we were determined that it would meet the recommendation by the Institute of Medicine to allow all students the opportunity to gain education in the field of public health. In addition, the epidemiology course would help educate students from a variety of disciplines on scientific method in a framework of public health. The course would also meet several LEAP guidelines for engaging students in learning that involves quantitative literacy, as well as increasing their understanding of civic responsibilities.

TABLE 1

Required courses for the public health minor

Required courses: minimum nine hours
Course Title
 
Credit Hours
HSCI 150
Introduction to Public Health
3
BIOL 110
Principles of Epidemiology
3
 
Take one statistics course:
STAT 241GS
Elementary Statistics
3
PSY 250
Behavioral Statistics
4
BMGT 233
Business Statistics
3
BIOL 305
Research Analysis
3

Once we chose the core courses, narrowing the field of appropriate electives was the next step. With so many possibilities, we found this a challenging task. We wanted all students to earn a similar public health minor while at the same time having flexibility to develop interests in topic areas that would benefit their majors.

Our review of courses offered at the university, as well as previous discussions with faculty from several departments, generated a new list of possible electives. Elective coursework in natural science, business, wellness, nutrition, social science, and psychology would be required to give students an overall look at the interdisciplinary aspects of public health. The elective courses fell into four general groups: (1) natural science, (2) business and management, (3) nutrition and wellness, and (4) related topics including family dynamics, sociology, and psychology. To keep continuity within the minor and provide depth to each student’s work, we determined that each student should take one course from each category. For example, all biology students would be required to take a business course. Business majors would learn in a lab-based science course. Other majors across campus would also experience new coursework outside their major fields.

Each of the four groups or categories offered multiple courses from which to select. The four groups of electives are listed in table 2.

TABLE 2

Elective courses for the public health minor

Take at least one course from each of the following groups for a minimum of fifteen credit hours.

Group 1: Natural Science
Course Title
 
Credit Hours
BIOL 211GS
Human Microbiology
4
BIOL 215GS
Human Physiology
4
BIOL 225 /226
Anatomy and Physiology
8
BIOL 401
Principles of Immunology
4
BIOL 440
Infectious Disease
4
BIOL 461
Human Genetics
3
BIOL 465
Physiology
3
BIOL 468
Parasites
2
CHEM 145GS
Introductory Chemistry
4
CHEM 150GS
Introduction to Organic and Biochemistry
4
CHEM 160GS
General Chemistry
and CHEM 160LLab
3
1
CHEM 161 GS
General Chemistry
and CHEM 161L Lab
3
1
CHEM 300
Environmental Chemistry
4
CHEM 301
Techniques of Chemical Analysis
4
CHEM 351
Biochemistry
4
 
Group 2: Business and Management
Course Title
 
Credit Hours
ECON 410
Health Care Economics
3
BMGT 355
Organizational Behavior
3
BMGT 301
Principles of Management
3
BMGT 380
Human Resource Management
3
BMKT 300
Principles of Marketing
3
BMKT 336
Services Marketing
3
BMKT 435
Marketing Research
3
BMKT 438
Consumer Behavior
3
BMKT 450
Pharmaceutical Marketing
3
BMIS 282
Decision Support Software, Decision Making, and Databases
3
BMIS 302
Principles of Management Information Systems
3
 
Group 3: Nutrition and Wellness
Course Title
 
Credit Hours
FSID 110GS
Nutrition
3
PE 160GS
Healthful Living
3
PE 229
Wellness Interventions
3
PE 468
Public Health Aspects of Physical Activity
3
 
Group 4: Related Topics
Course Title
 
Credit Hours
SID 351GS
Marriage and Family Relationships
3
FSID 150GS
Lifespan Development and the Family
3
FSID 450
The Aging Adult
3
FSID 481
Cross-Cultural Family Patterns
3
PSY 192
Death and Dying
1-3
PSY 203GS
General Psychology
3
PSY 230GS
Human Development
3
PSY 462
Adult Development and Aging
3
BIOL 311
Bioethics
3
SOC 250GS
Anthropology
3
SOC 462
Sociology of Health and Illness
3
SPAN 103
Spanish for Special Purpose-Medical Professionals
1-3
BIOL 325
Medical Terminology
1

 

Key for abbreviations in tables 1 and 2
BIOL:
biology
BMGT:
business management
BMIS:
marketing and management information systems
BMKT:
marketing and management information systems
CHEM:
chemistry
ECON:
economics
FSID:
family studies and interior design
HSCI:
health sciences
PE:
health, PE, recreation, and leisure studies
PSY:
psychology
SOC:
sociology
SPAN:
Spanish
STAT:
statistics

Permitting students a variety of choices in their electives allows flexibility so that students develop their own areas of focus in public health as well as satisfy curiosity about a topic relative to health. In addition, arranging courses in four general groups allows for easier modification (deletion or addition) of elective courses within each category by the public health curriculum committee while still maintaining a broad common outcome for students.

As we complete our first year of offering the minor, we will be making adjustments to the curriculum. Emerging national work has influenced our thinking. The CCAS consensus report was published after the minor had been through most of the approval process. We later participated in the July 2008 workshop sponsored by Association of American Colleges and Universities (AAC&U), the Association for Prevention Teaching and Research (APTR), and the Centers for Disease Control and Prevention (CDC), out of which came Recommendations for Undergraduate Public Health Education (AAC&U and APTR 2008). In addition, Kleinberg (2008) gave us insight into keeping a minor truly interdisciplinary by providing flexibility, spontaneity, and maintaining dependency on other departments. Using this information, we have been able to evaluate and adjust our curriculum.

One addition to the minor will be a separate course on global health, a three-hour requirement, replacing statistics. Statistics (a 200-level course) will become an elective. We expect epidemiology to be taught with significant health-related statistics, including odds ratio, risk ratio, attack rate, prevalence rate, mean, and central tendencies (with standard deviation) . These particular calculations can be covered within the course. We considered this decision with care, mindful of the value of global health study and aware that Recommendations suggests that statistics be presented in an integrative way through quantitative reasoning in other courses. Global health will be taught at the 300 level; students will have taken Public Health 101, Epidemiology 101, and electives in the four groups. We are recommending the higher numbering of the course as well as prerequisites so that deeper and richer content can be explored.

Additionally, we will add an elective independent study course. The course will ask students to apply public health concepts to their major areas of study. The course will be flexible, allowing students to develop a project of interest. Independent study could involve research, service learning, or community-based volunteer work. A communication major might write a brochure or video that could be shared with elementary school students on a health topic (such as the importance of vaccines or how to clean a cut properly). A business major might join a nursing home administrator to determine how to budget for rehabilitation equipment. Biology students could design a research project on the quality of well water in rural homes located near feedlots or irrigated fields. Students may volunteer with local public health departments or other service-related programs. We will develop guidelines and assessments to maximize the experience. This elective should be ideal for students wishing to demonstrate integration of public health with their major to enhance their employment opportunities. In addition, students planning to continue in graduate or professional school might use the research or service activities as part of their application.

During our first year, we have had students from many majors taking public health coursework. Some of these majors include biology, athletic training, exercise science, economics, business administration, family studies, and psychology. A number are preparing for medical school. Many students are taking public health courses to complete the minor. Currently the number of students in the minor indicates that it is one of the most popular on campus (the others being biology, health science, marketing/management, and social work). Some students are taking courses in public health before pursuing a master’s degree in the field or entering other areas of health care. Others have a general interest in the topic or see value in applying their learning personally, becoming healthier adults.

We are pleased to see the diversity of students and interests in the field and are confident we are meeting our goals. We expect continued growth in interest in public health at our university, and we know that the curriculum too must continue to evolve. Public health is a dynamic field. As the discipline changes, so will the courses and design of the minor. The challenge facing all such ventures is to maintain the interdisciplinary nature, flexibility, and dependency on other departments while staying true to the goals of the program.

References

Gebbie, K., L. Rosenstock, and L. M. Hernandez. 2003. Who will keep the public healthy? Educating public health professionals for the 21st century. Washington, DC. National Academics Press.

Kleinberg, E. 2008. Interdisciplinary studies at a crossroads. Liberal Education 94 (1): 6–11.

Riegelman, R. K., and S. Albertine. 2008. Recommendations for undergraduate public health education. Washington, DC: Association for Prevention Teaching and Research.

Riegelman, R. K., S. Albertine, and N. A. Persily. 2007. The educated citizen and public health: A consensus report on public health and undergraduate education. Williamsburg, VA: Council of Colleges of Arts and Sciences.


Debra A. Mowry is with the department of biology; Peggy Abels is with health science programs—both of the University of Nebraska–Kearney.

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